American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Effect of a perineal protection device in vacuum-assisted births—a prospective randomized controlled interventional trial","authors":"Anna Hoeller MD , Jana Birri MD , Nicole Ochsenbein-Koelble MD , Anne Richter MD , Roland Zimmermann MD , Nina Kimmich MD","doi":"10.1016/j.ajogmf.2024.101532","DOIUrl":"10.1016/j.ajogmf.2024.101532","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Birth tears are common after vaginal birth with a prevalence of up to 85%, especially in vaginal-assisted births. Because birth trauma can cause physical and psychological short-term and long-term maternal morbidity, it is essential to improve maternal outcomes at birth.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to evaluate the effect of a perineal protection device on the rate of spontaneous birth tears in the posterior compartment in vacuum-assisted births and the feasibility and safety of the device.</div></div><div><h3>STUDY DESIGN</h3><div>In a prospective, randomized controlled interventional trial from July 2020 to October 2022, we evaluated the application of a perineal protection device in vacuum-assisted vaginal births in a tertiary care center. A total of 1998 patients were asked to participate, and 1574 patients with singletons at ≥36 weeks of gestation gave their informed consent before birth. Ultimately, 209 were included according to a power calculation, performed in advance, with a statistical power of 80% and a significance level of 5% for an expected reduction in the rate of the primary composite outcome of 20%. The primary composite outcome was the rate of low-grade perineal and/or vaginal tears in the posterior compartment. Secondary outcomes were the rate of high-grade perineal tears and episiotomies, the feasibility of the device, and its safety for the mother and child. Descriptive statistics and a logistic regression analysis were performed in an intention-to-treat, a per-protocol, and an as-treated analysis, using SPSS, version 29.0.0.0, and R. A <em>P</em> value of <.05 was considered statistically significant.</div></div><div><h3>RESULTS</h3><div>Of the 1574 patients, 249 (15.8%) had an indication for vacuum-assisted vaginal birth, and 217 (13.8%) of those were randomized. An addition 8 patients (0.5%) were excluded because the birth ended without vacuum assistance. Of the remaining 209 patients, 105 formed the intervention group (application of the device), whereas 104 formed the control group (without application of the device). No differences in primary and secondary outcomes were found in the intention-to-treat and per-protocol analysis. In the intention-to-treat analysis, 79 patients (75.2%) in the intervention group and 73 patients (70.2%) in the control group (<em>P</em>=.4) met the primary endpoint. In the per-protocol analysis, the primary composite outcome was seen 53 patients (77.9%) in the intervention group and in 73 patients (70.2%) in the control group (<em>P</em>=.27). For the as-treated analysis, 68 of the 105 patients (65%) remained in the intervention group after exclusion of 37 (35%) patients with failed application of the device. Consequently, 141 formed the control group. In the as-treated analysis, there was also no difference in the primary composite outcome between the 2 groups (53 patients [77.9%] in the intervention group and 99 patients [70.2%] in","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101532"},"PeriodicalIF":3.8,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antihypertensive therapy and unplanned maternal postpartum healthcare utilization in patients with mild chronic hypertension","authors":"Anna Palatnik MD ,&nbsp;Justin Leach PhD ,&nbsp;Lorie Harper MD, MSCI ,&nbsp;Baha Sibai MD ,&nbsp;Sherri Longo MD ,&nbsp;Lorraine Dugoff MD ,&nbsp;Kirsten Lawrence MD, MSCE ,&nbsp;Brenna L. Hughes MD, MSc ,&nbsp;Joseph Bell MD ,&nbsp;Rodney K. Edwards MD, MS ,&nbsp;Kelly S. Gibson MD ,&nbsp;Caroline Rouse MD ,&nbsp;Lauren Plante MD ,&nbsp;Kara K. Hoppe DO, MS ,&nbsp;Janelle Foroutan MD ,&nbsp;Methodius Tuuli MD ,&nbsp;Hyagriv N. Simhan MD, MS ,&nbsp;Heather Frey MD, MSCI ,&nbsp;Todd Rosen MD ,&nbsp;Torri D. Metz MD, MS ,&nbsp;Alan T.N. Tita MD, PhD","doi":"10.1016/j.ajogmf.2024.101525","DOIUrl":"10.1016/j.ajogmf.2024.101525","url":null,"abstract":"<div><h3>Objective</h3><div>To test whether treatment of mild chronic hypertension (CHTN) in pregnancy is associated with lower rates of unplanned maternal healthcare utilization postpartum.</div></div><div><h3>Methods</h3><div>This was a secondary analysis of the CHTN and pregnancy study, a prospective, open-label, pragmatic, multicenter, randomized treatment trial of pregnant people with mild CHTN. All patients with a postpartum follow-up assessment were included. The primary outcome was unplanned healthcare utilization, defined as unplanned postpartum clinic visits, Emergency Department (ED) or triage visits, or unplanned hospital admissions within 6 weeks postpartum. Differences in outcomes were compared between study groups (Active Group: blood pressure goal of&lt;140/90 mm Hg, and Control Group: blood pressure goal of &lt;160/105 mm Hg), and factors associated with outcomes were examined using logistic regression.</div></div><div><h3>Results</h3><div>A total of 2293 patients were included with 1157 (50.5%) in the active group and 1136 (49.5%) in the control group. Rates of unplanned maternal postpartum healthcare utilization did not differ between treatment and control groups, (20.2% vs 23.3%, <em>P</em>=.07, aOR 0.84, 95% CI 0.69–1.03). However, ED or triage/maternity evaluation unit visits were significantly lower in the Active group (10.2% vs 13.2%, <em>P</em>=.03, aOR 0.76, 95% 0.58–0.99). Higher BMI at enrollment and cesarean delivery were associated with higher odds of unplanned postpartum healthcare utilization.</div></div><div><h3>Conclusion</h3><div>While treatment of mild CHTN during pregnancy and postpartum was not significantly associated with overall unplanned healthcare resource utilization, it was associated with lower rates of postpartum ED and triage visits.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101525"},"PeriodicalIF":3.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical resources for effective postpartum parenting (PREPP): a randomized controlled trial of a novel parent-infant dyadic intervention to reduce symptoms of postpartum depression","authors":"Myrriam D. Grubb BA ,&nbsp;Claire A. Wilson MRCPsych, PhD ,&nbsp;Zhijun Zhang MPH ,&nbsp;Grace Liu MS ,&nbsp;Seonjoo Lee PhD ,&nbsp;Catherine Monk PhD ,&nbsp;Elizabeth A. Werner PhD","doi":"10.1016/j.ajogmf.2024.101526","DOIUrl":"10.1016/j.ajogmf.2024.101526","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;There is little known about the effectiveness of psychological interventions to prevent postpartum depression that focus on the birthing parent and infant dyad. Risk factors for PPD include depression during pregnancy, low parenting self-efficacy, and disrupted parental nocturnal sleep. The brief Practical Resources for Effective Postpartum Parenting (PREPP) intervention is designed for pregnant individuals at-risk for postpartum depression, providing them with 1) caregiving strategies aimed at reducing infant fuss and cry behavior and increasing infant sleep, 2) self-reflection and mindfulness skills and 3) psychoeducation about the postpartum period and infant behavior. The aims are to set more realistic postpartum expectations, enhance parenting confidence and sleep via supporting infant regulatory behavior, improve parental affect regulation and ultimately reduce the risk of postpartum depression.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Assess the effectiveness of PREPP compared to enhanced treatment as usual in reducing symptoms of depression and anxiety and episodes of infant fuss and cry behavior and improving parental and infant sleep in the early postpartum.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study design&lt;/h3&gt;&lt;div&gt;A randomized controlled trial was conducted of 175 pregnant individuals. Inclusion criteria were standard prenatal care for a singleton pregnancy, aged 18 to 45 and at increased risk of PPD as determined by a score of ≥19 on the Predictive Index of Postnatal Depression or ≥7 on the Edinburgh Postnatal Depression Scale. Participants assigned to the PREPP group (n=88) received 3 coaching sessions and 2 phone check-ins. Participants assigned to the enhanced treatment as usual group (n=87) received 3 sessions which included psychoeducation, mood assessments, and clinical referral and follow-up as indicated. Assessments were conducted at 28 to 32 weeks and 34 to 39 weeks gestation, and at 6, 12 and 16 weeks postpartum and included measures of parental depression, anxiety and sleep (Edinburgh Postnatal Depression Scale, Patient Health Questionnaire (PHQ-9), Hamilton Rating Scales of Depression and Anxiety and Pittsburgh Sleep Quality Index) and infant sleep and fuss and cry behavior (Baby Day Diary).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Compared to enhanced treatment as usual, PREPP significantly reduced depressive symptoms at 6, 12 and 16 weeks postpartum with medium to large effect sizes (d=0.7-0.98). Compared to enhanced treatment as usual, participants receiving PREPP reported less of a decline in sleep quality at 6 weeks postpartum (p=0.035) and the effect size was large (d=0.83). Moreover, parents receiving the PREPP intervention reported less infant fussing and crying, with the largest effect for morning crying (&lt;em&gt;p&lt;/em&gt;&lt;.001; d=-1.48).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;The results provide evidence that PREPP, initiated during pregnancy, reduced symptoms of parental depression and infant fuss and cry be","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101526"},"PeriodicalIF":3.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of the obstetrics and gynecology clerkship and “hands-on” participation in deliveries","authors":"Katherine Lambert MD,&nbsp;Deborah Engle EdD,&nbsp;Melody Baldwin MD, MPH,&nbsp;Lorene Temming MD, MSCI,&nbsp;Sarah K. Dotters-Katz MD, MMHPE","doi":"10.1016/j.ajogmf.2024.101527","DOIUrl":"10.1016/j.ajogmf.2024.101527","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101527"},"PeriodicalIF":3.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated B-type natriuretic peptides predict resistant hypertension in patients with postpartum severe preeclampsia: a prospective cohort study","authors":"Walter Annicchiarico MD ,&nbsp;Ángel Vásquez MD ,&nbsp;José Santacruz MD, MS(c) ,&nbsp;Leidy Villamizar MD ,&nbsp;Enrique Ramos-Classon MD, MSc ,&nbsp;José Rojas-Suarez MD, MSc","doi":"10.1016/j.ajogmf.2024.101530","DOIUrl":"10.1016/j.ajogmf.2024.101530","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101530"},"PeriodicalIF":3.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient perspectives on research participation during labor and delivery","authors":"Melissa Cantave MD,&nbsp;Rachel Paul MPH,&nbsp;Lori Atwood,&nbsp;Brianna Bradley BS,&nbsp;Alicia Collins BS,&nbsp;Jessica Battle BS,&nbsp;Kristina Allen BA,&nbsp;Paige Wilder BS,&nbsp;Jaime R. Strickland MA,&nbsp;Ebony B. Carter MD, MPH,&nbsp;Jeannie C. Kelly MD, MS,&nbsp;Fan Zhang MD,&nbsp;Antonina I. Frolova MD, PhD,&nbsp;Nandini Raghuraman MD, MSCI","doi":"10.1016/j.ajogmf.2024.101531","DOIUrl":"10.1016/j.ajogmf.2024.101531","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101531"},"PeriodicalIF":3.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in severe maternal morbidity following an institutional team goal strategy for disparity reduction","authors":"Adina R. Kern-Goldberger MD, MPH, MSCE ,&nbsp;Adi Hirshberg MD ,&nbsp;Abike James MD ,&nbsp;Lisa D. Levine MD, MSCE ,&nbsp;Elizabeth Howell MD, MPP ,&nbsp;Elizabeth Harbuck BSN RN ,&nbsp;Sindhu K. Srinivas MD, MSCE","doi":"10.1016/j.ajogmf.2024.101529","DOIUrl":"10.1016/j.ajogmf.2024.101529","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Racial disparities in maternal pregnancy outcomes, specifically in morbidity and mortality, are persistent in the U.S., and a multifaceted approach to mitigating these disparate outcomes is critical. In 2020, our health system committed to reducing severe maternal morbidity (SMM) in Black patients, employing multiple strategic interventions including implicit bias training, regular reporting of a composite SMM metric stratified by race and ethnicity, standardization of best practices, focused efforts for hemorrhage risk reduction, and system-wide team building.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;The goal of this study is to investigate trends in SMM by race across this period of concentrated interventions to improve maternal outcomes overall, and specifically for Black patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;This is a retrospective cohort study evaluating all delivery admissions at an academic, urban, tertiary-care hospital in Philadelphia—one site of a health system encompassing five delivery hospitals—over a 3-year period from 2019 to 2021. Data including patient demographics, clinical features, and outcomes were extracted from the electronic medical record (EMR). Self-reported race was categorized as Black vs non-Black as documented in the EMR. SMM was defined according to established CDC indicators as well as additional codes identified by Vizient for common sources of SMM including hemorrhage, infection, and embolism. Data were analyzed by year with a multivariable logistic regression model including insurance type and obstetric comorbidity index (OB-CMI), a weighted scoring system accounting for numerous chronic medical conditions and antepartum pregnancy complications.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In total, 12,339 deliveries were included, 64.6% (&lt;em&gt;N&lt;/em&gt;=8012) of which were to Black patients. Median OB-CMI score was higher for Black patients at 3 (interquartile range [IQR] 1–5) compared to 2 (IQR 1–4) for non-Black patients, &lt;em&gt;P&lt;/em&gt;&lt;.01. There was a significant decrease in SMM for the entire cohort over the study period (8.5% in 2019 to 6.5% in 2021, &lt;em&gt;P&lt;/em&gt;=.001), driven by a decreased rate specifically among Black patients (8.9% in 2019 to 6.6% in 2021, &lt;em&gt;P&lt;/em&gt;=.005) with a nonsignificant decrease for non-Black patients (7.8% in 2019 to 6.3% in 2021, &lt;em&gt;P&lt;/em&gt;=.21). The adjusted model similarly demonstrated decreased risk of SMM over time for Black patients (2020 vs 2019 adjusted odds ratio [aOR] = 0.81, 95% confidence interval [CI] 0.69–0.96; 2021 vs 2019 aOR 0.73, 95% CI 0.62–0.86).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Dedicated efforts to improve equity in maternal outcomes over a 2-year period (2020–2021) in this hospital serving a Black patient majority were associated with a significant decline in SMM, especially among Black patients. This finding demonstrates the success of a high-level, coordinated, and systematic approach in reducing SMM and associated dispa","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101529"},"PeriodicalIF":3.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cohen vs Pfannenstiel cesarean skin incision for body mass index ≥35 kg/m2: a randomized controlled trial","authors":"Rebekah J. McCurdy MD, MPH, PhD ,&nbsp;Siani Harding BA ,&nbsp;Laura Felder MD ,&nbsp;Anita Beáta DO ,&nbsp;Peter Schnatz DO ,&nbsp;Vincenzo Berghella MD","doi":"10.1016/j.ajogmf.2024.101528","DOIUrl":"10.1016/j.ajogmf.2024.101528","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;Maternal obesity is recognized as a significant risk factor for adverse pregnancy outcomes, including increased cesarean delivery rates and heightened surgical complications. It is unclear whether the Cohen or Pfannenstiel skin incisions for cesarean delivery are associated with different outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OBJECTIVE&lt;/h3&gt;&lt;div&gt;This study aimed to evaluate the effect of a Cohen or Pfannenstiel cesarean skin incision on maternal morbidity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;Pregnant individuals with a body mass index of ≥35 kg/m&lt;sup&gt;2&lt;/sup&gt;, carrying either singleton or multiple pregnancies, were consented prenatally and in labor. Eligible participants who underwent a cesarean delivery between 24 and 41 weeks of gestation were randomized to either the Pfannenstiel or Cohen skin incision group at Thomas Jefferson University Hospital from October 2016 to March 2020. This study aimed to recruit 284 participants based on a sample size calculation, assuming a 50% reduction in wound complications with Cohen vs Pfannenstiel incisions (80% power; α=.05). However, recruitment was terminated early after 72 participants were randomized. The primary outcome was a composite maternal morbidity within 6 weeks, which consisted of the following: wound infection, hematoma, seroma, separation of skin of ≥1 cm, readmission for wound complications, endometritis, and postpartum hemorrhage. Statistical analyses included bivariate tests, &lt;em&gt;t&lt;/em&gt; tests, and nonparametric analyses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Of 331 pregnant individuals who consented prenatally and in labor, 72 eventually underwent cesarean delivery and were randomized, 34 to the Cohen skin incision group and 38 to the Pfannenstiel skin incision group. The mean body mass index was &gt;42 kg/m&lt;sup&gt;2&lt;/sup&gt;. Approximately two-thirds of the patients had a pannus, 56% of the patients were Black, 47% of the patients had diabetes mellitus, and 56% of the patients had hypertensive disorders. The primary outcome of composite maternal morbidity occurred in 47.1% of patients in the Cohen incision group and 36.8% of patients in the Pfannenstiel incision group (risk ratio, 1.24; 95% confidence interval, 0.71–2.08) and was similar regardless of the presence of a pannus or degree of obesity. Surgical site infection, hematoma, seroma, wound separation/dehiscence, endometritis, and postpartum hemorrhage were similar between the Cohen and Pfannenstiel groups. In addition, neonatal outcomes were similar between the Cohen and Pfannenstiel groups, except that the Cohen incision group was found to have a statistically significantly lower Apgar score at 5 minutes and a higher need for respiratory support than the Pfannenstiel incision group, possibly related to the trend for a longer time from skin incision to delivery. Physicians were found to be significantly less satisfied with the Cohen incision than the Pfannenstiel incision.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSION&lt;/h3&gt;&lt;div&gt;In","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101528"},"PeriodicalIF":3.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between antepartum admission and postpartum depressive symptoms","authors":"John R. Soehl MD ,&nbsp;Kathryn Anthony MD ,&nbsp;Chloe N. Matovina MD ,&nbsp;L.G. Ward PhD ,&nbsp;Laura R. Stroud PhD ,&nbsp;Emily S. Miller MD, MPH","doi":"10.1016/j.ajogmf.2024.101518","DOIUrl":"10.1016/j.ajogmf.2024.101518","url":null,"abstract":"<div><h3>Background</h3><div>Postpartum depression affects 14% of pregnant individuals and is a leading cause of preventable maternal mortality. Complications of pregnancy, such as preterm labor or pre-eclampsia, may require hospitalization for close monitoring and management. The impact of an antenatal hospitalization during pregnancy on postnatal depression remains understudied.</div></div><div><h3>Objective</h3><div>To evaluate whether hospital admission during pregnancy was associated with postpartum depressive symptoms in individuals who were enrolled in a collaborative care model and to evaluate whether enrollment in the collaborative care model during pregnancy mitigated this association.</div></div><div><h3>Study Design</h3><div>This secondary analysis of a prospective cohort study included perinatal people enrolled in a collaborative care model at a quaternary academic center between 2017 and 2021. The primary outcome was presence of moderately severe or severe postpartum depressive symptoms at 6 weeks postpartum defined as a score of 15 or greater on a PHQ-9. The prevalence of symptoms of this severity was compared between those who experienced an antepartum hospitalization and those who did not using bivariable and multivariable analyses. A Breslow Day test was used to evaluate whether any observed association between antepartum hospitalization and postpartum depressive symptoms differed based on timing of enrollment in the collaborative care model.</div></div><div><h3>Results</h3><div>During the study period, 1897 individuals met inclusion criteria. Of these, 162 (8.5%) were admitted to the hospital during pregnancy. Of those with an antepartum hospitalization, 20 (12.4%) developed moderately severe to severe postpartum depressive symptoms compared to 136 (7.8%) of those who were not hospitalized (<em>p</em>=.046). After adjustment for confounders identified through use of a directed acyclic graph, this difference did not persist in multivariable analysis (aOR 1.55, 95% CI [0.87−2.75]). A Breslow Day test demonstrated heterogeneity across enrollment timing, so subgroup analyses were performed for those enrolled during pregnancy (n=930) vs postpartum (n=967). Hospital admission was associated with higher rates of moderately severe to severe postpartum depressive symptoms in those enrolled in the collaborative care model postpartum (19.7% vs 10.6%, <em>p</em>=.015, aOR 2.25, 95% CI [1.07−4.71]), but not those enrolled antenatally (5.8% vs 5.0%, <em>p</em>=.735, aOR 1.09, 95% CI [0.38−3.19]).</div></div><div><h3>Conclusion</h3><div>Antepartum hospital admission was associated with higher rates of moderately severe to severe depressive symptoms. This association did not exist among individuals enrolled in collaborative care model during pregnancy, suggesting a potential protective effect afforded by engagement in a mental health support programming.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101518"},"PeriodicalIF":3.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of exome sequencing and chromosomal microarray for low-risk pregnancies: Cost-effectiveness of Prenatal Exome Sequencing.","authors":"Michal Rosenberg Friedman, Yariv Yogev, Sharon Maslovitz, Moshe Leshno, Lee Reicher","doi":"10.1016/j.ajogmf.2024.101512","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2024.101512","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the cost -effectiveness of exome and genome sequencing (ES), compared to Chromosomal microarray (CMA) METHODS: costs, utility and quality adjusted life years (QALYs) were modeled for prenatal testing with CMA or CMA+ES. Average costs and utilities were discounted at 3%. Two strategies for screening were compared using Markovian decision analysis model: (1) CMA only- abnormal result culminating in termination of pregnancy and normal test has with 1/160 chance for severe disorders. (2) ES after a normal CMA, for positive result a termination of pregnancy (TOP) was conducted. One - way sensitivity analysis for all variables. Outcome measures included the QALYs after abortion, cost of CMA and ES test and the health expenses of a critically ill infant. The time horizon of the model was 20 years.</p><p><strong>Results: </strong>Total costs were $1,348 and $3,108 for CMA and CMA+ES strategies respectively. The QALYs with time horizon of 20 years were 14.15 and 14.19 QALYs for CMA and CMA+ES strategies respectively with incremental cost-effectiveness ratio (ICER) of 46,383$/QALYs. Sensitivity analysis revealed that the time horizon and the dis-utility of moderate/severe disability of the genetic disorder has an impact on the ICER. For example, with a relatively small disutility of moderate/sever disability, the ICER is 84,291$/QALYs and for a shorter time horizon of 10 years, the ICER is 94,148$/QALYs.</p><p><strong>Conclusion: </strong>Exome has the potential to be cost-effective compared with CMA alone. Our research provides data regarding the cost-effectiveness of ES without specific indication that will become increasingly important in the near future as whole exome sequencing becomes the first-tier test in prenatal diagnosis.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101512"},"PeriodicalIF":3.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}